糖尿病患者视网膜神经纤维层OCT测量的形态学观察

背景 传统的观点认为,糖尿病视网膜病变（DR）的主要病理机制是视网膜的微血管病变,但近年来发现糖尿病患者的视功能改变发生于DR的微血管病变发生之前,传统的观点无法解释糖尿病患者在出现可辨认的血管改变之前已有视功能改变的现象. 目的 应用频域光学相干断层扫描（OCT）观察无视网膜血管改变的糖尿病患者、非增生性糖尿病视网膜病变（NPDR）患者视网膜神经纤维层（RNFL）厚度的改变,分析糖尿病患者RNFL厚度与DR的关系. 方法 收集2012年10月至2013年9月于山西省眼科医院就诊且确诊的2型糖尿病患者56例60眼,按DR国际临床分型标准分为非糖尿病视网膜病变（NDR）组26例30眼和NPDR组（轻中度NPDR）30例30眼,同期纳入年龄和性别匹配的健康志愿者30人30眼作为对照.应用OCT对受试者行RNFL厚度测量,包括视盘周围及中心凹周围视网膜360°平均RNFL厚度及鼻上、颞上、颞侧、颞下、鼻下、鼻侧区域的RNFL厚度,比较各组患者RNFL厚度的变化. 结果 NDR组、NPDR组和正常对照组受试者视盘周围平均RNFL厚度分别为（97.46±8.65）、（100.69±16.35）和（109.22±8.69）μm,其中NDR组、NPDR组受试者视盘周围平均RNFL厚度值均低于正常对照组,差异均有统计学意义（P=0.001、0.006）;NDR组视盘周围各象限RNFL厚度均较正常对照组变薄,颞上、颞侧、颞下和鼻下象限RNFL厚度的差异均有统计学意义（P=0.001、0.001、0.001、0.010）;NPDR组视盘周围各象限RNFL厚度均较正常对照组变薄,其中颞上、鼻侧区域RNFL厚度的差异均有统计学意义（P=0.001、0.046）.NDR组、NPDR组和正常对照组平均黄斑区RNFL厚度分别为（33.47±3.39）、（36.81±3.21）、（38.18±2.16）μm,NDR组、NPDR组受试者黄斑区平均RNFL厚度值均低于正常对照组,其中NDR组与正常对照组比较差异有统计学意义（P=0.001）;NDR组黄斑区各区域RNFL厚度较正常

Morphology of retinal nerve fiber layer in diabetic patients by optical coherence tomography

Background Conventional studies showed that the primary pathological change of diabetic retinopathy （DR） is retinal microangiopathy.However,recent studies found that the disorder of visual function appears prior to retinal microangiopathy in diabetic patients.Thereby,this findings can not be explained by conventional view.Objective The aim of the study was to find the change of retinal nerve fiber layer （RNFL） by frequency domain optical coherence tomography（OCT） in the diabetic patients without retinal microangiopathy and with non-proliferative DR （NPDR） and investigate the relationship between the change of RNFL thickness and DR.Methods Sixty eyes of 56 patients with 2 type diabetes mellitus were enrolled in Shanxi Eye Hospital from October 2012 to September 2013.The patients were divided into the non-diabetic retinopathy （NDR） group （30 eyes of 26 patients） and NPDR group （30 eyes of 30 patients） depending on the findings of fundus fluorescine angiography （FFA） according to the DR International Clinical Classification System.Thirty normal eyes of 30 age-and gendermatched healthy volunteers were included as controls.RNFL thicknesses around optical disc and macular zone were measured by OCT,including average RNFL thickness in 360°,superior nasal,superior temporal,temporal,inferior temporal,inferior nasal and nasal RNFL thicknesses.The measuring results were compared between the three groups.Results The total average thickness values of RNFL around the optic disc for the NDR group,NPDR group and the control group were （97.46-± 8.65） μm,（100.69 ± 16.35） pm and （109.22 ± 8.69） μm,respectively,and the parameters in the NDR group and NPDR group were significantly lower than those in the normal control group （P=0.001,0.006）.The RNFL thicknesses were thinning at the superior temporal,temporal,inferior temporal,inferior nasal quadrants around optical disc in NDR group compared with the normal control group （P=0.001,0.001,0.001,0.010）,and RNFL thickness values of